Robotic-Assisted versus Laparoscopic Distal Pancreatectomy: The Results of a Case-Matched Analysis from a Tertiary Care Center

Abstract

Background: Laparoscopic distal pancreatectomy (LDP) has been adopted relatively slowly despite the benefits of minimally invasive approach. The robotic approach can overcome the limitations of LDP, thus increasing the acceptance of minimally invasive distal pancreatectomy. Methods: We performed a 1: 1 retrospective case-matched comparison among 2 groups of 35 patients who underwent robotic-assisted distal pancreatectomy (RDP) or LDP from August 2014 to April 2017. Results: The operative time was similar in both groups (230 RDP vs. 205 LDP min, p = 0.382). The robotic group had a lower estimated blood loss (95 vs. 275 mL, p = 0.035). The spleen preservation rate was higher in the RDP group (100 vs. 66.7%, p = 0.027), while the conversion rate to open surgery was higher in the laparoscopic group (14.3 vs. 2.9%, p = 0.048). The overall complication rate was lower in the robotic group (25.7 vs. 37.1%, p = 0.044). There was no statistically significant difference in oncologic outcomes between the groups in terms of R0 resection rate (100% RDP vs. 85% LDP, p = 0.233) and number of harvested lymph nodes (14.4 RDP vs. 10.8 LDP, p = 0.678). Conclusions: The RDP showed a lower estimated blood loss, conversion, and morbidity rate. It offered a higher spleen preservation rate in comparison to LDP while maintaining comparable oncologic outcomes.

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

“…In robot-assisted distal pancreatectomy (RDP), the oncological outcomes of R0 resection rate and number of retrieved lymph nodes were comparable to those of laparoscopic and open DP. 93,[113][114][115][116] A study reported that the long-term prognosis associated with RDP, however, was significantly better than that associated with open DP. 116 In addition, the mortality rate and oncologic outcomes of robot-assisted pancreaticoduodenectomy (RPD) were comparable…”

Short- and long-term outcomes after minimally invasive versus open spleen-saving distal pancreatectomies

“…[ 20 21 22 23 24 ] The robotic approach has also been reported to be associated with superior spleen and splenic-vessel preservation rates compared to that of conventional laparoscopy. [ 25 26 33 ]…”

“…[ 18 19 ] Numerous studies have also compared robotic versus laparoscopic approaches for distal pancreatectomy, showing that the robotic approach is a safe and feasible alternative approach with comparable perioperative and oncological outcomes compared to that of the laparoscopic approach,[ 20 21 22 23 24 ] and may even have better spleen and vessel preservation rates. [ 25 26 ]…”

“Kimura-first” strategy for robotic spleen-preserving distal pancreatectomy: experiences from 61 consecutive cases in a single institution

“…Splenectomy is associated with increased risks of infection and a In the era of advanced minimally invasive pancreatic surgery, some existing studies have shown equivalent outcomes of laparoscopic and robotic surgeries (10,23). However, compared to LDP, RDP shows advantages in both splenic and splenic vessel preservation (24,25). These advantages may be attributed to the high flexibility of robotic instruments and precise suturing both in the dissection of splenic vessels and in the control of bleeding of the splenic vessels.…”